Wednesday, February 12, 2014

U.S. health coverage is too categorical

Here's a clear example of "American exceptionalism," albeit not the kind we should be proud of:

In other advanced industrial democracies, especially in Europe, health insurance, pensions and even certain amounts of income support for working-age adults are considered rights, to which everyone is entitled by virtue of their membership in society and their shared vulnerability to life’s vicissitudes.

 In the U.S., where health care is not considered a right, many do believe in "Work or Starve," as well as, apparently, "Work or Be Sick." What's even more bizarre in the U.S., Lane believes, are the exceptions we make to that:

This helps explain the oddest aspect of the nature of U.S. health insurance: It’s categorical. In the United States, people get coverage based not on membership in society but on membership in a discernible segment of society: elderly, disabled, military, employee, union member, child living below the poverty line and so on.

Everyone else — from relatively well-to-do self-employed consultants to dishwashers at small restaurants, for whom even tax-subsidized insurance is unaffordable — falls into the category of “other.” They make do with no insurance or with whatever is available on the dicey market for individual coverage.

Because health insurance works best with a broad risk pool, and because “everyone” is the broadest possible risk pool, the categorical U.S. system is plagued by obvious yet intractable inefficiencies and inequities.

Sadly, many Americans still believe that it's perfectly OK for an able-bodied but poor adult to go without health coverage.  Them's the breaks!

By Charles Lane
February 11, 2014 | Washington Post

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